Article

MRI in multiple sclerosis: a review of the current literature.

Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, Massachusetts, USA.
Current opinion in neurology (impact factor: 5.43). 06/2012; 25(4):402-9. DOI:10.1097/WCO.0b013e328354f63f pp.402-9
Source: PubMed

ABSTRACT This review summarizes the recent data pertaining to the use of magnetic resonance imaging (MRI) in assessing brain and spinal cord involvement in multiple sclerosis (MS).
Using MRI as a tool, investigators have made progress recently in understanding the substrate and mechanisms underlying the development and evolution of focal lesions and diffuse damage in MS. The application of refined MRI sequences has markedly improved the characterization of focal lesions, in particular cortical lesions. Promising improvements have been made to clarify the pathological specificity and sensitivity of MRI techniques by performing combined histopathologic-MRI correlation studies. The use of high-field (3 T) and ultra-high-field (UHF; >3 T) MRI has further facilitated the detection of both gray matter and white matter microstructural damage, and elucidated the topographic relationship of overt damage to venous blood vessels. The development of advanced MRI postprocessing tools has led to additional progress in detecting clinically relevant regional gray matter and white matter damage.
MRI continues to play a pivotal role in the investigation of MS. Ongoing advances in MRI technology should further expand the current understanding of pathologic disease mechanisms and improve diagnostic, prognostic, and monitoring ability in patients with MS.

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    Article: Multiple sclerosis and the blood-central nervous system barrier.
    Alan M Palmer
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    ABSTRACT: The central nervous system (CNS) is isolated from the blood system by a physical barrier that contains efflux transporters and catabolic enzymes. This blood-CNS barrier (BCNSB) plays a pivotal role in the pathophysiology of multiple sclerosis (MS). It binds and anchors activated leukocytes to permit their movement across the BCNSB and into the CNS. Once there, these immune cells target particular self-epitopes and initiate a cascade of neuroinflammation, which leads to the breakdown of the BCNSB and the formation of perivascular plaques, one of the hallmarks of MS. Immunomodulatory drugs for MS are either biologics or small molecules, with only the latter having the capacity to cross the BCNSB and thus have a propensity to cause CNS side effects. However, BCNSB penetration is a desirable feature of MS drugs that have molecular targets within the CNS. These are nabiximols and dalfampridine, which target cannabinoid receptors and potassium channels, respectively. Vascular cell adhesion molecule-1, present on endothelial cells of the BCNSB, also serves as a drug discovery target since it interacts with α4-β1-integrin on leucocytes. The MS drug natalizumab, a humanized monoclonal antibody against α4-β1-integrin, blocks this interaction and thus reduces the movement of immune cells into the CNS. This paper further elaborates on the role of the BCNSB in the pathophysiology and pharmacotherapy of MS.
    Cardiovascular Psychiatry and Neurology 01/2013; 2013:530356.
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Keywords

current understanding
 
detecting clinically relevant regional gray matter
 
diffuse damage
 
gray matter
 
histopathologic-MRI correlation studies
 
magnetic resonance imaging
 
MRI postprocessing tools
 
multiple sclerosis
 
Ongoing advances
 
overt damage
 
pathologic disease mechanisms
 
pivotal role
 
recent data pertaining
 
refined MRI sequences
 
review summarizes
 
spinal cord involvement
 
topographic relationship
 
venous blood vessels
 
white matter damage
 
white matter microstructural damage
 

Antonia Ceccarelli